초록 열기/닫기 버튼
목적 : 관상동맥 질환은 이미 한국인의 주요 사망원인으로 증가일로에 있지만 그에 대한 자세한 역학적, 인구학적인 통계가 부족한 실정이다. 저자 등은 전향적인 대규모 임상연구를 통해 관동맥 질환의 임상양상과 치료실태, 예후 등을 알아보고자 하였다. 방법 : 1999년 12월부터 2003년 4월까지 가톨릭의대 8개 부속 병원에 입원하여 관동맥 질환을 진단받은 1,665명을 대상으로 임상양상을 조사하였으며, 2003년 9월까지 추적관찰이 가능하였던 965명을 대상으로 예후에 영향을 미치는 인자에 대하여 분석하였다. 결과 : 관동맥 질환으로 입원한 환자의 진단명은 급성심근경색증이 가장 많았고, 관동맥 질환의 위험인자들 중 고혈압, 흡연, 당뇨병 등의 빈도가 높았다. 이상지혈증은 1,151명에서 관찰되어 비교적 높은 유병률을 보였으나, 주요 심장사건의 event-free survial에 영향을 미치는 독립적인 인자가 아니었다. 1,665명 중 1,217명에서 관동맥 조영술을 시행한 결과, 단일 혈관질환이 419명(32.2%)으로 가장 많았다. 약 2년간 추적가능하였던 965명을 관찰한 결과 주요심장사건은 15.1% (146명), 심장사는 2.2% (21명)가 발생하였다. 치료방법에 따른 생존분석 결과, 내과적인 치료만 시행한 경우에 관동맥 중재시술을 시행한 경우보다 주요 심장사건에 대한 event- free survival 낮았으나 사망률에는 양군간에 차이가 없었다. Cox regression 분석 결과, 주요 심장사건의 독립적인 예측인자는 다혈관 질환과 중재시술이었고, 심장사망에 대한 독립적인 예측인자는 70세 이상의 고령과 내과적 보존적 치료만 시행한 경우였다. 특히 급성관동맥 증후군환자는 중재시술을 시행한 경우에 사망에 대한 event-free survival이 높게 나타났다. 결론 : 관동맥 질환으로 입원하였던 한국인 환자는 중재시술을 시행한 경우에 주요심장사건에 대한 event- free survival이 낮았고, 심장사망에 대한 event-free survival은 양 군 간에 차이가 없었다. 하지만 급성관동맥증후군에서는 관동맥중재시술을 시행하는 것이 생존에 우월한 결과를 보였다.
Background : Coronary artery disease (CAD) has recently become one of the major causes of mortality and morbidity in Korea. However, not much epidemiologic and demographic data has yet been reported. The purpose of this study was to investigate the clinical features as well as the prognostic factors of patients with CAD. Methods : We prospectively enrolled 1,665 consecutive patients with CAD who had been admitted to the Catholic University Hospitals from December 1999 to April 2003. Results : Acute myocardial infarction (AMI) was the most common cause of admission (n=715, 42.9%). Dyslipidemia, hypertension and smoking were the most common risk factors. More than 70% of the patients who underwent percutaneous coronary intervention (PCI) received stent implantation. A total of 965 (612 males) patients were followed at least for 6 months (the mean follow-up duration was 23.8±12.2 months). The incidence rates of major adverse cardiac events (MACE: cardiac death, acute myocardial infarction, target vessel revascularization) and cardiac death were 15.1% (n=146) and 2.2% (n=21), respectively. There was no difference in overall survival between the patients treated with medical therapy and those treated with PCI. By Cox regression analysis, the independent prognostic factors for MACE were PCI (95% CI: 1.75-4.85; p<0.01) and multivessel disease (95% CI: 1.03-2.04; p<0.05), and the independent prognostic factors for cardiac death were medical therapy (95% CI: 1.08-14.41; p<0.05) and old age (95% CI: 1.13-16.13; p<0.05). Conclusions : There was no difference in overall survival between the patients treated with medical therapy and those treated with PCI. However, PCI was superior to medical therapy for preventing death of the patients with acute coronary syndrome.(Korean J Med 73:142-150, 2007)
Background : Coronary artery disease (CAD) has recently become one of the major causes of mortality and morbidity in Korea. However, not much epidemiologic and demographic data has yet been reported. The purpose of this study was to investigate the clinical features as well as the prognostic factors of patients with CAD. Methods : We prospectively enrolled 1,665 consecutive patients with CAD who had been admitted to the Catholic University Hospitals from December 1999 to April 2003. Results : Acute myocardial infarction (AMI) was the most common cause of admission (n=715, 42.9%). Dyslipidemia, hypertension and smoking were the most common risk factors. More than 70% of the patients who underwent percutaneous coronary intervention (PCI) received stent implantation. A total of 965 (612 males) patients were followed at least for 6 months (the mean follow-up duration was 23.8±12.2 months). The incidence rates of major adverse cardiac events (MACE: cardiac death, acute myocardial infarction, target vessel revascularization) and cardiac death were 15.1% (n=146) and 2.2% (n=21), respectively. There was no difference in overall survival between the patients treated with medical therapy and those treated with PCI. By Cox regression analysis, the independent prognostic factors for MACE were PCI (95% CI: 1.75-4.85; p<0.01) and multivessel disease (95% CI: 1.03-2.04; p<0.05), and the independent prognostic factors for cardiac death were medical therapy (95% CI: 1.08-14.41; p<0.05) and old age (95% CI: 1.13-16.13; p<0.05). Conclusions : There was no difference in overall survival between the patients treated with medical therapy and those treated with PCI. However, PCI was superior to medical therapy for preventing death of the patients with acute coronary syndrome.(Korean J Med 73:142-150, 2007)
키워드열기/닫기 버튼
Coronary disease, Intervention, Prognosis
